Suicide & Stigma: Sikkim's multifaceted social issue that remains unresolved - I

Sikkim stands at the second position in the rate of suicides with 33.1

Suicide & Stigma: Sikkim's multifaceted social issue that remains unresolved - I

Sikkim’s history of the stigma around mental illness and suicides is not an uncommon, unpopular fact. Most urban classes discuss these topics as coffee table banter and within that, one might find self-appointed pseudo-philosophers who quote, “There is one truly serious philosophical problem and that is suicide”, a statement written by Albert Camus in The Myth of Sisyphus which is an essay on the absurdity of human condition, and somehow romanticize the idea of suicide. Shallow debate and perspective not only endanger the speaker’s IQ but might lead another to question something far more disturbing.

Those living in rural areas regard suicides and mental illnesses as a casual and sometimes, supernatural affair. There are spiritual interventions or sometimes violence measures taken to keep the afflicted under control.

The dearth of mental health professionals and the ignorance of its high rate of suicide (which is still significant, our total population being a little over 6 lakhs as per the 2011 Census data) by not just the higher echelon of administrations but also by district and smaller unit officials, along with the stigma around mental health may be the biggest cause of such a terrifying state.

The NCRB data 2019

As every year, the National Crime Records Bureau comes out with an annual report on the statistics of the crimes, accidental deaths and suicides of the nation. In the most recent report, Sikkim stands at the second position in the rate of suicides with 33.1% after Andaman and Nicobar Islands which stands at 45.5%. 

Rate of suicides is the number of suicides per one lakh population and according to NCRB, “has been widely accepted as a standard yardstick for comparison.” 

The data shows that:

  • ‘Family Problems’ and ‘Illness’ were the major causes of suicides which accounted for 32.4% and 17.1% of total suicides respectively during 2019. ‘Drug Abuse/ Addiction’ (5.6%), ‘Marriage Related Issues’ (5.5%), ‘Love Affairs’ (4.5%), ‘Bankruptcy or Indebtedness’ (4.2%), ‘Failure in Examination’ and ‘Unemployment’ (2.0% each), ‘Professional/Career Problem’ (1.2%) and ‘Property Dispute’ (1.1%) were other causes of suicides. 

  • Housewives accounted for 51.5% of the total female victims (21,359 out of 41,493) and constitute nearly 15.4% of total victims who committed suicides (21,359 out of 1,39,123) during 2019. 

  • The age group (18 - below 30 years) and persons of 30 years - below 45 years of age were the most vulnerable groups resorting to suicides. These age groups accounted for 35.1% and 31.8% suicides respectively. 'Family Problems' (2,468), ‘Failure in Examination’ (1,577), ‘Love Affairs’ (1,297) and ‘Illness’ (923) were the main causes of suicides among children (below 18 years of age). 

Despite the various programmes and schemes on mental health awareness, it seems that it isn’t enough to prevent people from taking their lives. The above data shows clearly that women and young people are those who have been successful in ending their lives. 

Even within this data, there are faults. Where are the statistics for the LGBTQ+ community? Or caste-based suicides? Somewhere, the nation’s database erases the lives and deaths of minority groups, leading to more disillusionment and despair. 

It is worth noting that this was before the COVID-19 pandemic broke out. The NCRB report that will come out for the year 2020 will probably show a greater increase unless the government claims that there is “no data”, which is the current favourite phrase of political and administrative leaders. 

The Media’s Role

Google “suicides in Sikkim 2019” and a couple of news stories will pop up but largely, there are some incidents that remain unreported. Is our media looking the other way? Are these stories not newsworthy? Are mental health awareness and suicide prevention month/week/day boiling down to one article and the topic left to catch dust on the shelves of news editors until the next year?  

Whether it is conscious ignorance or unconscious bias in reporting or their language, Sikkim’s press fraternity needs to take this issue more seriously than ever. The media still needs to reach a point before they can call themselves sensitized on suicide/mental health reportage. Generally, Sikkim’s reporters, journalists and editors find themselves smack in the middle of politics (sometimes petty) and press releases/conferences (sometimes insensible), which ends up filling news slots and only here or there, a couple of opinion pieces find their way into their platform, talking about issues that citizens should know more about. 

How then, can this be fixed?

One cannot expect the press fraternity to completely ditch hot stories and delve into bringing about the discourse on mental health or suicides overnight. As someone said, Rome wasn’t built in a day. Neither will this conversation. Each time a reporter questions their local administrators and political leaders, why can’t mental health policies or the rights of minorities come into a proposal? Why only ask “how do you feel about so and so”?

Political leaders should make mental health a priority before the citizens declare that they care for topple like dominos, unable to access resources and treatment due to economic instability, social stigma and fear of vulnerability. 

The COVID-19 has crippled the Indian economy and left thousands suffering in its wake yet the news is overridden by petty politics and press releases and doubtful propagandas, leaving citizens to their misery. 

Just as producing content for Pride month in June and forgetting about the LGBTQ+ community’s struggles as soon as it gets over, the same can’t be done just for the weeks in September, which is Suicide Prevention and Awareness month. Journalists, reporters, anchors, producers and editors all need to amplify the need of the hour. The pandemic has given a slice of what it feels like to be caged in homes and heads. 

Suicides in Sikkim - September 2020

On 18th September, a 31-year-old died by suicide and the investigation by local police showed that he had been mentally disturbed ever since his younger brother passed away by the same means. Rituals to help the former after the brother’s death, as a way to help him cope and bring him out of his trauma were carried out by the family, except his condition worsened. In this particular incident, the family members believed that a spiritual intervention would fix the mental ordeal of witnessing a sibling’s untimely death. 

The same day, in another part of East Sikkim, a 27-year-old woman jumped into a water reservoir located at Selep Tank in Gangtok. Investigation revealed that the deceased allegedly suffered from seizures and epilepsy, for which she was being treated at STNM Hospital. It was known to her family that she had suicidal thoughts. So where was the intervention and treatment that could’ve helped her? Or was she too far gone, as most people are likely to justify by reading her case? It was reported that she was seen by villagers heading towards the water reservoir tank - so why didn’t anybody stop her?

Four days later, a 32-year old Indian Reserve Battalion jawan was found dead in his bathroom and the cause of death was ruled as suicide. 

Now the question is, what would have happened if there had been a more practical intervention through proper access to mental healthcare and therapy by licensed professionals? Would these lives have been saved? 

The Proposed and Working (sort-of) Solutions

Ask any individual what they should do if someone feels suicidal, and the first solution is “call the suicide helpline” - but what if that doesn’t work? What is the next step? Medicine, the answer arrives. Yet the fact remains that all medicines leave a terrible side effect on the body. 

Suicide helplines in India mostly do not pick up calls, as much as the belief is that they do. There are too many people suffering within the walls of their mind and the handful of good mental health professionals are either too busy or inaccessible to tend to everyone. This is, however, not a judgment on them. Societies have been taught to treat people with mental illnesses as social outcasts or see them as a threat to the pseudo-peace of their communities. 

Stigmatization and undermining the seriousness of mental health is only going to push the ones in need of help further back. It is not enough to be addressing the personal. Unemployment, discrimination of caste/class/gender/sexuality, alienation, digitization, productivity seen as the mark for one’s value, the pressure to become an imagined ‘perfect’ - all of this is beyond the personal.

Dr Satish Rasaily, MD Psychiatry cum Postdoctoral Fellowship in Addiction Medicine, Singtam District Hospital, says that previously patients who were suffering from any sort of mental illness took years before seeking help from the doctors, explaining that spiritual interventions - the usage of local priests and shamans - were more culturally significant than visiting a medical practitioner.

“Now, in a few villages, people have begun seeking help. District Counselling Centres that are set up in all districts, psychiatrists and counsellors have been providing help not for mental illness but also for mental well-being.” He adds that they have been sensitizing even the local jhakris about mental health. “In the last 3-4 years, the state’s rate of suicide is reducing from a decade ago and I believe that is because of the various campaigns undertaken.”

On suicides, he says that when one gets suicidal thoughts, it should be taken as a symptom of illness and visit the hospital. The psychologist and psychiatrist will later determine the cause of it but ultimately, when someone has suicidal thoughts, you must immediately seek help as you would for diabetes or hypertension”.

“India has about 6,000 psychiatrists/psychologists in total and Sikkim has around 15, which is a good ratio for our population,” says Rasaily.

He also believes that “if you don’t want to get depressed, you should have a purpose” - which is all well and good, but what about those who do have one yet still find it impossible to keep on living? 

This shouldn’t be misunderstood as a judgement on the medical community because some of them have truly tried their best to educate themselves and each other, except, growing up and around a society that normalizes stigmatization of substance abusers, mental health and those who attempt suicide/self-harm makes it hard to unlearn a lot of internalized discrimination. 

When the external world is unforgiving to mistakes and differences, it makes the internal hard to empathize in the way one wants to. The only way to make a change now remains by active learning and engagement with each other. Communities need to listen, not talk over, dismiss, ridicule or advise people going through a difficult time. There has never been a better time to show up and lend help as gently as one can, than now.  

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